Multi-Fraction Radiation Treatment
Clinicians should consider the use of multi-fraction in lieu of single fraction radiation treatment to reduce the risk of fracture in patients with metastatic carcinoma in the femur.
Treatment of Metastatic Carcinoma and Myeloma of the Femur
Joint MSTS/ASTRO/ASCO Guideline
MODERATE RECOMMENDATION Rationale
One randomized study of moderate quality (Van Der Linden 2003) demonstrated that multi- fraction radiation therapy was associated with a lower risk of femoral fracture compared to single-fraction radiation therapy. In the absence of other randomized data, the strength of this recommendation was
upgraded to moderate given the significant morbidity associated with post- radiation femoral fractures which impact weight bearing and quality of life. In patients with limited life expectancies, a single fraction may be suitable to limit time on radiation treatment.